Health economic evaluations of reperfusion treatments and stroke care organizations

Stroke is a leading cause of disability. Improving treatment pathways is crucial for enhancing outcomes and reducing the economic burden. This thesis presents studies evaluating the cost-effectiveness of reperfusion treatments (Chapters 2 and 3) and organizational strategies (Chapters 4–7) for acute ischemic stroke in the Netherlands. Chapter 2 compares the benefits of tenecteplase over alteplase, demonstrating that tenecteplase is a more cost-effective option with better clinical outcomes while saving costs. Chapter 3 investigates the cost-effectiveness of administering intravenous thrombolysis before thrombectomy for large vessel occlusion patients, showing that intravenous thrombolysis prior to thrombectomy is potentially cost-effective at higher willingness-to-pay thresholds. Chapter 4 reviews strategies to reduce onset-to-treatment times, finding that interventions like educational programs, telemedicine, and workflow improvements are cost-effective across various healthcare settings. Chapter 5 explores the direct transfer to angiography suite strategy, which streamlines in-hospital patient routing and is cost-effective, particularly in regions with robust prehospital triage tools. Chapter 6 evaluates the drive-the-doctor paradigm, where interventionalists travel to primary stroke centers to perform thrombectomy, showing that it is cost-effective compared to the traditional drip-and-ship model. Chapter 7 assesses the cost-effectiveness of upgrading primary stroke centers to thrombectomy-capable stroke centers, showing that additional thrombectomy-capable stroke centers may be cost-effective, yet only if they maintain high thrombectomy volumes.This thesis provides valuable insights into optimizing stroke care pathways, highlighting the need for efficient treatment strategies and well-organized regional networks to improve clinical outcomes and manage healthcare resources effectively.

Dissertation: https://hdl.handle.net/11370/21125d38-6868-4205-a361-1a4804a475cd